1. Field of the Invention
The invention relates to the field of enteral feeding tubes such as gastrostomy tubes and jejunostomy tubes, and unclogging such tubes.
2. Description of Related Art
Many people who are too ill to feed themselves, for example, they are not able to eat, swallow food or medication, and the like (such as from cancer, neurological disorders, etc.) are typically fed through enteral feeding tubes. Enteral nutrition is a type of hyperalimentation and metabolic support in which nutrient formulas or medicaments can be delivered directly to the gastrointestinal tract, i.e., enteral feeding involves delivery of nutrients, etc., directly into the stomach, duodenum or jejunum. Long-term enteral feeding tubes can be gastrostomy tubes (G-tubes), jejunostomy tubes (J-tubes) and nasogastric tubes (NG-tubes). Such in-dwelling tubes work well, but have a tendency to clog.
In a gastrostomy tube, a feeding tract (or stoma) is created between the stomach and upper abdominal wall. Feeding is performed generally by administering food through a catheter or feeding tube inserted into the stoma, the distal end extending into the stomach and generally bolstered against the wall of the stomach. Gastrostomy tubes typically extend through the skin (i.e., percutaneously) into the stomach. Such tubes are generally surgically placed below the rib cage and slightly off to the left. G-tubes are easy to replace compared to other tubes and provide patient comfort and convenient care.
Jejunostomy tubes differ from G-tubes in that they are typically surgically implanted in the upper section of the small intestine (jejunum) just below the stomach. J-tubes are located lower and more towards the center of the abdomen than G-tubes. J-tubes are used when there is a need to bypass the stomach and to feed a patient directly into the intestinal tract. Such patients are generally fed with an enteral feeding pump. J-tubes may be secured by suturing.
Nasogastric tubes are used for patients who cannot ingest nutrients by mouth. The tube is placed in either nostril, passed down the pharynx through the esophagus and into the stomach, and is more usually associated with short-term feeding, unlike G- and J-tubes.
While all such tubes clog, more often, it is long-term enteral feeding tubes for critical care or long-term illness patients where clogging presents the greatest concern (i.e., in G-tubes and J-tubes). As such, tubes can be affected by the body, by backlog of nutrients or medicaments and the like, and the tubes themselves or the exit holes in the distal ends thereof can become blocked required unclogging and/or replacement of the tubes. Such clogging happens reasonably frequently and presents a significant challenge to long-term care. Generally, the first step in unclogging an enteral feeding tube is that if a nurse is present, he may flush the tube with fluids and/or other unclogging agents (such as water, ginger ale, powders and different dissolving agents, etc.) under pressure (such as through a syringe) to unclog the holes and/or the feeding tube. When this fails, the patient may have to have the tube replaced. Frequent tube replacement for long-term feeding tubes is expensive, can require visits to clinics or hospitals for long-term critical care patients in nursing homes, rehabilitation centers and convalescence centers. This can create a significant burden both financially and through use of resources (ambulances, EMT personnel, etc.). This process also is also a cause of great discomfort and presents danger to the patient each and every time feeding is cut off.
The prior art presents several potential solutions to the long-term enteral feeding tube clogging issue. U.S. Pat. No. 4,894,056 as well as a product known as the Introreducer™ are directed to small polycarbonate tubes that can be slipped down into an enteral feeding tube for forcing warm water or unclogging solution into the tube using the pressure distributor portion of the device.
International Patent Publication No. WO 92/12756 teaches a device for unclogging a J-tube. The device has a blunted end and a threaded portion. By rotating the handle of the device, it unclogs the tube by having the threaded portion dislodge and lift the clog from the tube. By twisting, it is hoped that there is reduced risk of perforation of the intestine from prior art plunging methods.
U.S. Patent Publication No. 2002/0198502 A1 teaches a clog preventing device in which a corrugated tube is placed (longitudinally slid) over a feeding tube attachment to prevent clogging as a result of kinking, compression or other effects of patient movement while sleeping.
Some feeding tubes are formed with special clog-resistant ends having a “bolus” on the distal end thereof. For example, U.S. Pat. No. 4,594,074 teaches use of an enteral feeding tube opening having a “bolus” on the end with a non-clogging opening that is elliptically shaped and slopes upward so as to prevent clogging in feeding through the tube.
U.S. Pat. No. 6,283,719 discloses an improvement for pumping through indwelling feeding tubes. The system is designed to make the pressure changes more noticeable so the automatic pumping device can work properly by differentiating a clogging event from other changes in pressure. When an actual clog is detected, the device goes into “clog clearing mode.” The pump is said to be able to clear the clog without assistance of a nurse. The pump uses the feeding fluid in the system to unclog without the need to flush or use of other devices such as a flushing syringe or brush. The system remains in that mode until either the clog is removed or a preset period of time expires.
U.S. Pat. No. 7,041,083 teaches a low-profile percutaneous endoscopic gastrostomy tube in which there is a “tube-in-tube” configuration that allows for the primary gastrostomy tube to remain clean when feeding due to an inserted and removable tube. The primary tube extends from the stomach out of the device and folds over the main portion of the device.
U.S. Pat. No. 5,527,280 teaches a multilumen enteral feeding tube device in which there are three branches and three primary lumens. The main lumen is within a feeding tube that is a gastric tube having openings in tip to transmit feeding material or medicine to the stomach interior through one branch. Another branch of the device allows for introduction of a J-tube that runs through the center of the gastric tube coaxially allowing for introduction of materials to the intestines. A third lumen (fluid lumen) is defined within the wall of the gastric tube itself and is in communication with the further branch of the device for introducing fluid (air or water) to inflate or deflate a balloon using a syringe. The balloon is for securing the device in place when positioned in the patient.
While there have been attempts to unclog or prevent clogging of J- and G-tubes in patients on-site, such procedures have met with mixed results, and the primary technique still in use is flushing of the tube and/or replacement of the tube by the nurse or other health-care professional. Thus, there is still a need in the art for an improved device and/or method to easily unclog a J-tube, G-tube, NG-tube or other enteral feeding tube with the least disruption, inconvenience and discomfort to patients, thereby minimizing the need to visit a hospital or clinic for replacement of the tubes when standard unclogging procedures do not work.